Question 1

A 68-year-old woman has come in for an assessment of her rheumatoid arthritis,and the nurse notices raised,firm,nontender nodules at the olecranon bursa and along the ulna.These nodules are most commonly diagnosed as:

Accepted Answer

Subcutaneous nodules are raised,firm,and nontender and occur with rheumatoid arthritis in the olecranon bursa and along the extensor surface of the ulna.(See Table 22-3 for a description of the other conditions.)

Question 2

The nurse suspects that a patient has carpal tunnel syndrome and wants to perform the Phalen test.To perform this test,the nurse should instruct the patient to:

Accepted Answer

For the Phalen test,the nurse should ask the person to hold both hands back to back while flexing the wrists 90 degrees.Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand.The Phalen test reproduces numbness and burning in a person with carpal tunnel syndrome.The other actions are not correct when testing for carpal tunnel syndrome.

Question 3

The nurse has completed the musculoskeletal examination of a patient's knee and has found a positive bulge sign.The nurse interprets this finding to indicate:

Accepted Answer

A positive bulge sign confirms the presence of swelling caused by fluid in the suprapatellar pouch.The other options are not correct.

Question 4

An 85-year-old patient comments during his annual physical examination that he seems to be getting shorter as he ages.The nurse should explain that decreased height occurs with aging because:

Accepted Answer

Postural changes are evident with aging; decreased height is most noticeable and is due to shortening of the vertebral column.Long bones do not shorten with age.Intervertebral disks actually get thinner with age.Subcutaneous fat is not lost but is redistributed to the abdomen and hips.

Question 5

A woman who has had rheumatoid arthritis for years is starting to notice that her fingers are drifting to the side.The nurse knows that this condition is commonly referred to as:

Accepted Answer

Fingers drift to the ulnar side because of stretching of the articular capsule and muscle imbalance caused by chronic rheumatoid arthritis.A radial drift is not observed.(See Table 22-4 for descriptions of swan-neck deformity and Dupuytren contracture.)

Question 6

The nurse is examining a 3-month-old infant.While the nurse holds his or her thumbs on the infant's inner mid thighs and the fingers on the outside of the infant's hips,touching the greater trochanter,the nurse adducts the legs until the his or her thumbs touch and then abducts the legs until the infant's knees touch the table.The nurse does not notice any "clunking" sounds and is confident to record a:

Accepted Answer

Normally,this maneuver feels smooth and has no sound.With a positive Ortolani sign,however,the nurse will feel and hear a "clunk," as the head of the femur pops back into place.A positive Ortolani sign also reflects hip instability.The Allis test also tests for hip dislocation but is performed by comparing leg lengths.

Question 7

A professional tennis player comes into the clinic complaining of a sore elbow.The nurse will assess for tenderness at the:

Accepted Answer

The epicondyles,the head of the radius,and the tendons are common sites of inflammation and local tenderness,commonly referred to as tennis elbow.The other locations are not affected.

Question 8

A patient has been diagnosed with osteoporosis and asks the nurse,"What is osteoporosis?" The nurse explains that osteoporosis is defined as:

Accepted Answer

After age 40 years,a loss of bone matrix (resorption)occurs more rapidly than new bone formation.The net effect is a gradual loss of bone density,or osteoporosis.The other options are not correct.

Question 9

During an examination,the nurse asks a patient to bend forward from the waist and notices that the patient has lateral tilting.When his leg is raised straight up,the patient complains of a pain going down his buttock into his leg.The nurse suspects:

Accepted Answer

Lateral tilting and sciatic pain with straight leg raising are findings that occur with a herniated nucleus pulposus.The other options are not correct.

Question 10

A patient who has had rheumatoid arthritis for years comes to the clinic to ask about changes in her fingers.The nurse will assess for signs of what problems?

Accepted Answer

Changes in the fingers caused by chronic rheumatoid arthritis include swan-neck and boutonniere deformities.Heberden nodes and Bouchard nodules are associated with osteoarthritis.Dupuytren contractures of the digits occur because of chronic hyperplasia of the palmar fascia (see Table 22-4).

Question 11

An 80-year-old woman is visiting the clinic for a checkup.She states,"I can't walk as much as I used to." The nurse is observing for motor dysfunction in her hip and should ask her to:

Accepted Answer

Limited abduction of the hip while supine is the most common motion dysfunction found in hip disease.The other options are not correct.

Question 12

The nurse is teaching a class on preventing osteoporosis to a group of perimenopausal women.Which of these actions is the best way to prevent or delay bone loss in this group?

Accepted Answer

Physical activity,such as fast walking,delays or prevents bone loss in perimenopausal women.The faster the pace of walking,the higher the preventive effect is on the risk of hip fracture.The other options are not correct.

Question 13

During a neonatal examination,the nurse notices that the newborn infant has six toes.This finding is documented as:

Accepted Answer

Polydactyly is the presence of extra fingers or toes.Syndactyly is webbing between adjacent fingers or toes.The other terms are not correct.

Question 14

A patient is complaining of pain in his joints that is worse in the morning,better after he moves around for a while,and then gets worse again if he sits for long periods.The nurse should assess for other signs of what problem?

Accepted Answer

Rheumatoid arthritis is worse in the morning when a person arises.Movement increases most joint pain,except the pain with rheumatoid arthritis,which decreases with movement.The other options are not correct.

Question 15

A patient states,"I can hear a crunching or grating sound when I kneel." She also states that "it is very difficult to get out of bed in the morning because of stiffness and pain in my joints." The nurse should assess for signs of what problem?

Accepted Answer

Crepitation is an audible and palpable crunching or grating that accompanies movement and occurs when articular surfaces in the joints are roughened,as with rheumatoid arthritis.The other options are not correct.

Question 16

A teenage girl has arrived complaining of pain in her left wrist.She was playing basketball when she fell and landed on her left hand.The nurse examines her hand and would expect a fracture if the girl complains of a:

Accepted Answer

A fracture causes sharp pain that increases with movement.The other types of pain do not occur with a fracture.

Question 17

A 40-year-old man has come into the clinic with complaints of extreme pain in his toes.The nurse notices that his toes are slightly swollen,reddened,and warm to the touch.His complaints would suggest:

Accepted Answer

Clinical findings for acute gout consist of redness,swelling,heat,and extreme pain like a continuous throbbing.Gout is a metabolic disorder of disturbed purine metabolism,associated with elevated serum uric acid.(See Table 22-1 for descriptions of the other terms.)

Question 18

A mother brings her newborn baby boy in for a checkup; she tells the nurse that he does not seem to be moving his right arm as much as his left and that he seems to have pain when she lifts him up under the arms.The nurse suspects a fractured clavicle and would observe for:

Accepted Answer

For a fractured clavicle,the nurse should observe for limited arm range of motion and unilateral response to the Moro reflex.The other tests are not appropriate for this type of fracture.

Question 19

A patient is able to flex his right arm forward without difficulty or pain but is unable to abduct his arm because of pain and muscle spasms.The nurse should suspect:

Accepted Answer

Rotator cuff lesions may limit range of motion and cause pain and muscle spasms during abduction,whereas forward flexion remains fairly normal.The other options are not correct.

Question 20

A young swimmer comes to the sports clinic complaining of a very sore shoulder.He was running at the pool,slipped on some wet concrete,and tried to catch himself with his outstretched hand.He landed on his outstretched hand and has not been able to move his shoulder since.The nurse suspects:

Accepted Answer

A dislocated shoulder occurs with trauma involving abduction,extension,and external rotation (e.g.,falling on an outstretched arm or diving into a pool).(See Table 22-2 for descriptions of the other conditions.)

Quiz 22: Musculoskeletal System